Pathology History PDF

Pathology Mark Sholdice HS 2220 An illustration of pathology: Carswell’s tubercles tubercles: structural abnormalities in the lungs that are a symptom of advanced pulmonary tuberculosis Robert Carswell (1793-1857): Scottish doctor who trained under Pierre Louis in Paris pu...

Pathology Mark Sholdice HS 2220 An illustration of pathology: Carswell’s tubercles tubercles: structural abnormalities in the lungs that are a symptom of advanced pulmonary tuberculosis Robert Carswell (1793-1857): Scottish doctor who trained under Pierre Louis in Paris published a textbook in 1838 containing hundreds of Carswell’s drawings and paintings here we see the influence of the Paris School of Medicine’s What is pathology? medicine is more of an art or applied technology than a science many of medicine’s scientific claims to are based on pathology pathos: the Greek word for “suffering” modern definition is narrower: a system of knowledge used to draw conclusions about illness like anatomy and physiology, pathology has changed to reflect contemporary science and philosophy The functions of pathological study I explaining suffering humans seek meaning identification part of the diagnostic process also a compliment to physiology: defining abnormality and illness helps to define normality and health but cultural, political, and social assumptions can influence pathology in defining abnormality and illness The functions of pathological study II prediction prognosis justification diagnosis therapy Disease and illness a disease = a theory constructed to explain illness, its cause, and its possible outcomes central goal of pathology: constructing, recognizing, and treating disease Theories of disease organismic/individual theory diseases are bad, discontinuous, and affect individuals because individuals turn to medicine to get rid of diseases, they must be bad therefore, medical education based on recognizing, curing, and preventing disease ontological theory disease is a separate being or entity and comes from outside the patient physiological theory disease emerges from inside the patient and do not exist separately from the patient Non-material understandings of disease role of supernatural forces disease treated by restoration of spiritual balance or integrity disease seen as moral punishment sick blamed for their illness, either in supernatural (e.g. sin) or material terms (e.g. smoking) Greco-Roman antiquity Hippocratic pathology saw diseases in naturalistic terms, not supernatural (e.g. The Sacred Disease, about epilepsy) disease a result of humoral imbalance Galenic pathology dominates pathology in the West until early modern period, just like anatomy and physiology case histories of different pathologic conditions become canonical medical texts Medieval and Renaissance ideas al-Razi (Rhazes) (854-925 AD) clinical distinctions made between different conditions with similar rashes (measles and smallpox) work translated into Latin in 1280 Renaissance Europe Galenism declined and experimentation increased Thomas Sydenham (1624-1689) important in the development of “nosology” (system of classifying diseases, based on observation) separated scarlet fever from measles in 1676 and described chorea in 1686 influence of ontological theory: Sydenham and other nosologists described disease as external to patients Early pathological anatomy Antonio Benivieni (1443-1502) On Some of the Causes Unknown and Surprising of Diseases and Treatments: used 111 case histories of autopsies to describe "hidden" changes connected disease to alterations in the physical structure of the body (lesions) Théophile Bonet (1620-1689) Anatomical Graveyard (1679): a collection of abnormal anatomy, containing over 3,000 observations Giovanni Battista Margagni (1682-1771) The Seats and Causes of Diseases Investigated by Anatomy (1761): stressed importance of autopsies to clinical medicine; includes indexes of diseases and lesions Synthesis anatomy and clinical medicine “met” in early 1800s, with the rise of physical diagnosis new emphasis on lesions as evidence of disease importance of visual observations in 1829, Jean Cruveilhier (1791-1874) published first volume of illustrated text on pathological anatomy beginning in 1830s, microscopes were used to identify disease at the level of tissues (later, disease identified at cellular level) Disease as “invasion”: Germ theory Louis Pasteur (1822-1895) research work for agricultural industry (milk and wine contamination; anthrax) helped to prove germ theory Joseph Lister (1827-1912) Adopted Pasteur’s germ research by developing antiseptic surgery Robert Koch (1843-1910) identified mycobacterium tuberculosis as the cause of pulmonary tuberculosis Koch’s postulates to be proven the cause of a disease, the organism must: 1) be found in every case; 2) be isolated and grown in pure culture; 3) produce same disease when injected into animals; 4) and be recovered in all experimental cases Outcomes vaccines smallpox inoculation and vaccination practiced across Africa, Asia, and Middle East for centuries and adopted in Europe in 1700s germ theory research in late nineteenth century caused use of vaccines to spread hygiene movements germ theory applied, both directly and as an analogy, to public health problems medical research bacteriology established as scientific discipline; laboratories established in hospitals  Pathology as a discipline part of increasingly medical specialization in late nineteenth century in United States, Johns Hopkins Hospital (founded 1889) became model for medical education: both a teaching hospital and research centre in France, Pasteur Institute (founded 1887) became centre for study of infectious disease in Canada, William Osler (1849-1919) appointed as a pathologist at McGill University in 1874; joins Johns Hopkins in 1889 Principles and Practice of Medicine (1892) combined pathology with case descriptions In the popular imagination pathology captured the public imagination Why? Pathologist is like a detective examples Conan Doyle’s character Sherlock Holmes Arrowsmith (1925) by Sinclair Lewis P.D James and Agatha Christie (both worked in healthcare) TV’s Gregory House Disease and heredity germ theory is based on ontological theory of disease (disease comes from outside individual), but heredity is physiological in 1902, Archibald Edward Garrod (1857-1936) established that alkaptonuria is an inherited disease studies on fruit flies in early 1900s led to theory that heredity units existed on chromosomes: named “genes” in 1909 for decades, unclear how genetic discoveries could be applied to medicine but growing importance of genetic medicine after discovery of DNA structure in 1952 Contemporary Pathology current medical model uses both ontological and physiological theories of disease each theory has implications for politics and society ontological: stigmatizing populations thought to be unique vectors for disease physiological: blaming patients for their inherited diseases misuse of pathology as analogy and metaphor